We know it is only the beginning of October, but EVERYONE is already thinking about Halloween (we know you are)! There are so many fun, spooky, but also wholesome fall themes all around, like pumpkin EVERYTHING, little ghosts, the monster mash, and so so much more. Because this whole month seems to be filled with Halloween goodness, we wanted to bring you our Halloween themed exercises early, so you can practice them ALL MONTH LONG, all the way to October 31st! So let’s get Monster mashing, come on!

The Frankenstein Kick

Stand with your arms out straight in front of you, and walk forward while kicking your legs straight TEN times. Kick your hands if you can! Now you are doing the Frankenstein Kick!

The Zombie Drag

Lie on your tummy on the floor. Now drag yourself forward (aka do an army crawl) switching your arms 10 times! You can make this even harder if you pretend you are a Zombie who’s legs went missing and try to just move using your arms (it is so tricky).

The Pumpkin Roll

Sit on your pelvis, criss cross applesauce. Now hug your knees close to your chest with both arms. Roll toward one knee, forward, and then try to sit back up. If you keep going in the same direction, you will start moving in a circle, so try it 5 times to the right then 5 times to the left. If you can’t do this one it is okay it is very hard. An alternative position is the stable pumpkin: Hug your knees into your chest and hold for 10 seconds!

The Mummy Twirl

Pretend someone is wrapping you up in a whole roll of toilet paper (or actually use the toilet paper for this one and make it even more fun). Hold your imaginary or real toilet paper in between your arm and your side. Then twirl 10 times to the right to wrap yourself up tight like a mummy. Untwirl yourself by going 10 times to the left so you are not so dizzy (and not left mummified)!

The Flying Ghost

Okay, we are going for the scare factor on this one, kids. Jump as high as you can into the air, bring your arms up over your head, and say BOO! Repeat this 10 times in a row to be the SCARIEST ghost on the block!

And there you have it, ghouls! Have fun performing these exercises to let your inner monster out and to get in the Halloween spirit! Stay tuned this month for more Halloween themed fun and tips to last you the whole month of October. Have fun moving and grooving, and remember to keep it SPOOKY!

As we are finally back to school, it is important to also acknowledge and address the stress that may accompany a return to the school environment. Any transition to a new setting can be stressful, especially for children with disabilities. The combination of an unfamiliar environment, interactions with peers, classroom expectations, unpredictability, reduced control, change of routine, challenging coursework, facing the unknown, or the impact of disabilities can signal the stress system (aka sympathetic nervous system)  in our children’s bodies. This is also known as the fight, flight or freeze system. When faced with fear, uncertainty, a perceived threat, or the anticipation of a stressor our bodies will increase the stress messengers of the body (aka adrenaline and cortisol). This results in changes in breathing, heart rate, blood pressure, posture, concentration, and also systems like digestion. As this is a normal response in the human body, sometimes it can be overactive and can impact a child’s ability to engage with peers and learning activities. 

As parents/ educators/ therapists, our desire is that our kids thrive and enjoy learning about our crazy, cool world with confidence and curiosity. A calm, confident, and aroused state is key to this success in the classroom and with peers. Luckily, our body always tries to have a balance (homeostasis) by having its own checks and balance system. 

Introducing: the de-stress system (aka parasympathetic nervous system) which counteracts the stress messengers and helps achieve a calm state. Successful strategies of managing stress often include techniques that help stimulate this de-stress system. Such strategies include slow/ controlled breathing, postural alignment, reducing arousing stimulus, adjusting exposure to stressors, calming touch, engagement in a soothing activity, spending time in nature, and consistent exercise. 

Below are some practical tips to incorporate these de-stressing strategies into your household routine for your children and the whole family!

Recommendations:

1. Open and supportive communication 
   • Assist your child in processing events of the day, interactions they experience, and their emotions. Not only does this give you a glimpse of their day, but it also enhances child/ parent bonding and it provides your child with a safe and trusted place to process complex feelings and thoughts. One practical way is for each member of the household to discuss highs and lows of that day at a designated time. This is a good opportunity to model emotional regulation for your children, by showing how you as an adult also face highs and lows and move forward in healthy and productive ways. Decluttering the mind reduces stress.
2. Deep breathing
   • Slow, deep, controlled breathing stimulates the de-stress system. One way to do this is to have your child place their hands on their stomach and breathe in through their nose so that their stomach fills and pushes into their hands. Hold for 3-5 seconds and then slowly blow the breath out through the mouth. You can make it fun by placing a toy on their belly and watch it move up and down as they inhale/ exhale.
3. Yoga & Mindfulness
   • Yoga combines intense tactile input, exercise, and coordinated breathing which stimulates the de-stress system while also promoting strength, stability, and balance. One free resource is cosmic kids yoga on youtube which provides fun and popular, kid-specific themes. Mindfulness is another effective strategy to help stimulate a calm and self aware state that is ready to learn and engage with others. One resource that has a variety of mindfulness activities is the OT Toolbox blog (https://www.theottoolbox.com/mindfulness-for-kids/).
4. Address Sensory needs
   • Kiddos with sensory processing difficulties may also experience stress if they are over or under stimulated. Some children may be sensory seekers or instead sensory avoiders. Depending on the child, they may need increased or decreased sensory input to promote a calm state of arousal. An idea to address the needs of sensory seekers is to perform handstands against a wall when they arrive home from school. When sensory needs are significant and impacting their success at school and home, your child may benefit from a consultation with an occupational therapist.
5. Exercise and play
   • Research supports that individuals who engage in regular, consistent exercise have reduced baseline stress levels. There are also countless studies that support positive impacts of exercise on mental health, anxiety, and depression. After sitting in a classroom the majority of the day, it is important for our kiddos to engage in physically active play as this promotes their development and brain health.
6. Engage in Soothing Activities
   • Every person is unique and has different preferences for calming activities. Some examples can be listening to or playing music, going outside in nature, art, reading independently, story time with a caregiver, or journaling. The key is to find an activity that promotes a calm state for that specific child.
7. Reduce screen time
   • High levels of screen time are correlated with increased anxiety and depression with adolescents and teens. Although screen time can have a calming impact, take into consideration the lighting of the device and that screen time can be an isolating activity. 
8. Stress education
   • There is an expanding library of educational resources for children to better understand their bodies and how it processes stress. Knowledge and understanding of how our bodies work can help kids interpret why they feel certain thoughts, sensations, or emotions and provide them with effective strategies to stimulate the de-stress system independently. Here are two youtube videos that provide stress education for the adolescent and primary school aged child. https://www.youtube.com/watch?v=3Nf2Pzcketg (adolescent) https://www.youtube.com/watch?v=LYFofKgBHxU (child)
9. Adjust and limit exposure to stressors
   • Reducing activities that stimulate the stress system can also reduce your child’s stress level at school. Getting ready in the morning before school is a common example of a major stressor. So planning ahead, giving adequate time, incorporating routines, setting clear expectations, and setting clothes out the night before can eliminate the stress of rushing to get to the bus or school. Think about what are potential stressors for you and your child and how things can be adjusted to reduce that stressor.
10. Have fun
    • The happy chemicals that our brains produce when we are enjoying what we are doing also counteracts the stress system. What brings your child true joy? Incorporate that into their routine to promote wellbeing.

This post is for education purposes only. Please seek medical advice from a licensed health care provider that directly manages your care.

Further reading on stress:

WHY “Good Posture” is So Important for School!

by Dr. Ali

We are always hearing about “good posture” and how important it is for us. We hear “sit up straight” and “don’t slouch” often, whether you are saying it to your kiddo or you hear another parent or a teacher saying it to another kiddo. What is never partnered with these phrases is WHY this is so important. I wish that as a kid, somebody told me why sitting up tall was so important, because if they had, maybe I would have done it more instead of slouching!

Sitting with supported, aligned posture is SO important for every body, and for all mobility statuses. If you are curious as to WHAT good posture looks like, click HERE to read a blog post all about appropriate postural alignment and for some solutions to help with sitting posture throughout the school or work day. 

It’s also important to remember that a “good posture” is also one that you’re not in for too long!  We want to empower our kids to listen to and respond to what their bodies need- that may be using a standing desk for periods of the day or sitting on a wedge to support a more traditional aligned upright posture. However, we do want all of our kids to have the flexibility and postural control to sustain an actively aligned posture for periods of time.

SO, without further ado, we are here to tell you all about one of the BIGGEST benefits of sitting with nice, spinal alignment. And what is this benefit you ask? BREATHING! Sitting with your spine in a properly aligned position makes sure that your ribs are in the right places to allow for proper expansion when we breathe in. Sitting with our core activated, with our ribs and spine in a proper alignment ensures that your diaphragm (the big muscle that attaches to your ribs and sits below your lungs) is in the perfect position to contract and relax for breathing. With your ribs and spine in the right position, your lungs have enough room to expand and let in all the air they can. Then your breathing muscles (the diaphragm and more) are in the best position to bring in all that air (aka a win win)! When you sit up TALL, your breathing is not SMALL! 

So, WHY is breathing efficiently important for effective learning throughout the school day? Breathing in big, natural breaths gets oxygen into our lungs, which then gets taken all over the body. Our brain needs oxygen to think all the thoughts we need for our school lessons. The heart needs oxygen to keep beating with a strong and healthy rhythm. The arms and legs need oxygen to fuel their muscles to move and groove or patiently raise a hand to answer a question. The stomach and intestines need oxygen from the blood to digest your yummy lunch so you can turn it into energy! Basically, the WHOLE body needs oxygen to keep on keeping on and to continue doing what each part is supposed to do!

The body needs oxygen for SO many things! And not just any amount of oxygen, but the right amount of oxygen. If the lungs fill with too little oxygen, then the body is only working off of what it has, and maybe compensating for the energy it is missing. You may feel tired throughout the day, with lots of yawns and trouble focusing. This is something we definitely want to avoid when our kiddos go back to school! When they go to school for the day, we give them a hearty breakfast in the morning to make sure they have enough energy to last them until lunch time and a hearty lunch to get them through the rest of the day. BUT both of these amazing meals are not going to help them combat the tiredness they will feel if they are not breathing right all day long at school because of poor posture. 

Good posture and optimal breathing supports emotional regulation, by increasing access to the parasympathetic nervous system, the opposite of our “fight or flight system.”  It impacts a child’s ability to use their eyes, especially for desktop work, but also the ability to move back and forth between looking far at the teacher and looking close at desk work.  It also impacts handwriting and other fine motor skills. 

Our ability to sustain our posture over a long period of time is not only the result of the chair we are sitting on but also our body’s ability to sustain “good posture” using our muscles and sensory system. Some kids have a hard time with the muscular endurance or strength required for good posture. Others have a hard time sensing where their body is when sitting and thus sit in a very relaxed, forward curved posture. Some kids have a combination of both of these factors (and typically this is the case). If you notice your child sitting with slouched posture at home, you can probably assume they are sitting that way at school. If they are sitting that way at school too, they are not breathing in the most efficient way and may not be getting the proper amount of oxygen throughout the day for peak concentration! If you feel like this is your child, it is not something that can’t be helped and improved with physical therapy! Through physical therapy, your child can learn to support their body with supported posture and build the muscle strength and endurance to hold that posture for much longer stretches of time. If you feel like your child spends a large part of the day slouching when they sit, do not hesitate to call us at KidPT to schedule a free Discovery Visit so that we can screen your child to see if PT is appropriate for them, and if we are a good fit, to help them learn to sit with ease!

by Dr. Ali

This week we are going to get BUGGY! There are two different types of people out there, those who think bugs are really cool and helpful and those who think bugs are the scariest beings to walk on earth. Although bugs may not be some people’s favorite things, there are so many out in the summer, doing their little buggy jobs here and there. They are all so different from each other in shape, color, and especially in HOW THEY MOVE! Because of this, we thought it would be fun to bring you and your kiddos BUGGY MOVES this week!

The Butterfly Flap:

1. Stand up tall with your “wings” (arms) out to the side
2. Stretch your arms up all the way to the sky
3. Flap your arms sideways and down until they are at your sides
4. Keep repeating this until you have flapped your wings 10 times!

The Super Ant Pick Up:

1. Fill up a laundry basket FULL of “food” (clothes, whatever works)!
2. Pick up the laundry basket
3. Carry the laundry basket all the way to your “ant hill” (your room)
   1. Make sure to tell your kiddos about how strong ants are and how much they can lift to inspire them to act like an ant!
4. Repeat this 5 times total so your ant colony has enough “food” for the week!

The Jumping Spider:

1. Start in a crouched position on the ground (hands and feet touching the ground)
2. Scurry forward in this position and count to 1,2,3!
3. After the count of 3, JUMP into the air JUST like a jumping spider does
4. Repeat this 10 more times for 10 spider jumps!

The Scooting Worm:

1. Lie on the ground on your tummy with your arms up next to your ears. Make sure you have enough space to travel in a long line on the floor and that there is no clutter in your way!
2. Crawl your knees in, bent so that they get closer to your tummy. You will then be kneeling in a child’s pose.
3. Slide your arms forward until your tummy is on the ground again!
4. Repeat this 3 times, then turn around and come back to where you started.

We hope you enjoy these summer bug-tastic exercises! We know you are “bugging” out that summer is almost over (so are we) but we are trying to enjoy every last bit. Happy summer everybody (and every buggy), have fun squirming, jumping, and flying like our little friends do!

by Dr. Ali

Toe walking is something that is frustrating for many parents and their kids and our parents are often worried about their child’s balance or overall joint health of their feet and ankles as they age. The children are frustrated with always being told to walk on flat feet when they feel like they really can’t control how they are walking! We often hear “They’ll walk on flat feet when they’re thinking about it, but as soon as they stop thinking about how they are walking, they are back up on their toes again!” We hear this over and over again from parents. If you have been to another physical therapist for your child’s toe walking, often they just stretch, stretch, stretch them… your child is miserable and in pain AND there is often no change in their toe walking.

We look at toe walking a little differently. The body is a movement system if the system is not moving the way it is designed to, there must be a reason! The important question we therapists always ask is WHY! When a child walks on their toes, they are using a less efficient gait pattern than when a person walks with a heel to toe gait pattern. Our bodies are SMART and they are always trying to optimize their own movement efficiency naturally so that we can move with EASE. Basically all bodies take the path of least resistance, no matter what! That said, if a child is toe walking, it is DEFINITELY meeting an underlying need in their body, or else, they wouldn’t be walking that way. Toe walking IS their body’s path of least resistance. There is something blocking their body from walking with a heel toe gait pattern and making toe walking the easy way to move. THIS is where we pediatric PTs come in! There are many needs that their body might be trying to meet and we are here to help them fill in the little gaps that their body has not been able to do alone (up to this point). 

Postural and Biomechanical 

Sometimes, the origin of a child’s toe walking is related to their alignment and the way a child uses their core. When this is the primary reason for a child’s toe walking, we will often see the child leaning forward, belly out, with their whole center of mass (aka the middle of their body) positioned forward over their feet. If this is the primary driver of a child’s toe walking, then they need to re-learn how to use their belly muscles and how to re-align and control their whole body while moving before any changes are seen at their feet and ankles. 

Sensory

Sometimes toe walking can have a large contribution from the sensory system. Within this realm there could be multiple different sensory needs their toe walking may be meeting. Let’s look at these different needs a little more: 

• Tactile: Often the link between toe walking and tactile sensations (aka what you feel when something touches your skin) is related to something called tactile defensiveness. Simply put, if your child is tactile defensive, they dont like the way some sensations feel. If your child doesn’t like certain sensations and their toe walking changes when they walk on grass versus concrete or tile versus carpet, and etcetera, there could be something relating to their tactile system that is contributing to their toe walking.

• Visual: The development of the visual and visuomotor systems are tricky overall. As a child develops, their eye movements become more and more coordinated. By the age of three, most children have started to develop more mature visuomotor skills, like convergence (when the eyes work together to see things that are low and in the foreground). When we hear that a child did not start toe walking until about the age of three, we often suspect there is a visuomotor factor at play, though other factors may be present as well. If there is a visuomotor component, we typically refer the child to a professional called a Developental Optometrist who is the ideal healthcare provider to determine whether the eyes are coordinated and if eye movements are developmentally appropriate or if they are in need of a little help!

• Proprioceptive: when a child is trying to meet a proprioceptive sensory need by toe walking, they may be walking on their toes to gain extra sensory input from their feet. Proprioception is a sense we have in our muscles and joints that tells us where our body is in space. This is why proprioception helps us feel safe and grounded, because we can understand where our bodies are in relation to our environment. Sometimes, if a child has a proprioceptive system that is not accurately processing, such as with a child with low tone, the information the body is trying to give, the child may be unsure of where their feet are and their legs are in space when their feet are flat on the ground. Their innate solution for this is to rise up onto their toes to press the joints of the feet and ankles together, which then gives them more info about where their legs are.

Neuromuscular:

-Sometimes children who present with high tone or low tone can toe walk based on how their system regulates the tone in their muscles. High tone is frequently seen in children with Cerebral Palsy or children who have had a Traumatic Brain Injury, and in this sense, when the child moves or tries to walk, the tone in their calf muscles may increase to the point where they are walking up on their toes. In the case of low tone, similar to why children with impaired proprioceptive systems might toe walk, the child might be looking to stabilize joints which are more mobile. By toe walking, children with low tone are increasing their overall joint stability and thus the stability of their body while they move. Neuromuscular contributions to toe walking are more complicated as they require more time, patience, and retraining of the way the child regulates their tone while they move (which is often an automatic process and is only slightly understood by the medical community). The main reason why toe walking can be troublesome for this population, especially in the case of high tone, is that having the foot and ankle positioned in a pointed position while moving and likely while standing or resting too can create something called a contracture. A contracture is the term used when a joint loses movement in a certain direction to the point where it affects the intended function of that joint. When a contracture gets too severe, it might cause skin break down while a child is walking in certain shoes, which could lead to an infection down the line. Contractures are very hard to reverse once they occur and prevention is typically the preferred way to go!

If ANY of these descriptions (or a combination of these) sound like your child, they may benefit from physical therapy with the knowledge of how to treat idiopathic toe walking. Gone are the days of “stretching three times a day will make it better” because if you have done this with your child you KNOW that 9/10 time this does not work. At KidPT we treat idiopathic toe walking from the tummy out to the tips of the toes and don’t look over the potentially crucial contributing sensory factors. We will work with you and your child as a team to put the puzzle pieces together (and oh yeah did we mention they will have FUN while doing it). Stop stressing and start getting answers, come in to KidPT today for a Free Discovery Visit and see if WE are the right fit for YOU!